DOCSLIB.ORG

Cramp in Cases of Prolapsed Intervertebral Disc

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cramp in Cases of Prolapsed Intervertebral Disc J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.3.251 on 1 August 1949. Downloaded from J. Neurol. Neurosurg. Psychiat., 1949, 12, 251. Jr CRAMP IN CASES OF PROLAPSED INTERVERTEBRAL DISC BY LIONEL WOLMAN From the Department of Nervous Diseases, Royal Sheffield Infirmary and Hospital Although cramp has been mentioned as a symp- This procedure has since been abandoned in favour tom by several writers on the subject of prolapsed of complete curettage of the disc space. Of the 204 intervertebral discs (Bradford and Spurling, 1941; patients, 142 had division of one or more p6sterior ro6ts, O'Connell, 1943; Lenhard, 1947) no study has while the remaining sixty-two had no such division. The surgeon's decision whether to section the posterior hitherto been made of its exact nature, frequency, root was influenced by his estimate of the completeness and relationships. It was not until the routine of the disc removal and to a lesser extent by the severity follow-up of cases of sciatica, which had been of root pain. treated surgically, was begun that it was noticed that the symptom of painful cramps in the leg was fairly Type of Cramp.-In most cases the cramp came common in postoperative cases. This served to on at night while the patient was in bed. It affected focus attention on the symptom, and an inquiry the calf alone, the thigh alone, the foot alone, or about it was therefore made in all cases, both before combination of these. There was always associated Protected by copyright. and after operation. The purpose of this paper is pain, and the patient could always feel the muscle to record these observations, and if possible to harden or, in the case of the foot, see and feel the relate the' symptom to conditions found at, or toes being drawn down under the sole. These produced by, the operation, and to discuss the symptoms were always verified before a pain in the symptom in relation to theories now held on the leg was-called cramp. atiology of muscle cramp. When there had been cramp before operation, this symptom began after the onset of sciatica and Material never before. The most characteristic thing about The observations recorded here were made in the the postoperative cramps was that they were very Department of Nervous Diseases, Royal Sheffield frequent immediately after operation, occurriig Infirmary and Hospital, in a series of 204 cases of back- for ache and sciatica which were thought to be due to nightly or every other night the first few weeks, herniation of an intervertebral disc and were subjected and gradually becomi'ng less frequent so that they to operation. The patients were operated on between occurred about weekly or monthly twelve to the years 1939 and 1946 by Mr. James Hardman, and a eighteen months after operation. With a further routine follow-up examination was carried out in 1947, lapse of time they became very infrequent, occurring at least twelve months and up to seven years after only once every three or- four months. This operation. The figures given below are extracted from infrequency made observations on actual attacks http://jnnp.bmj.com/ the complete follow-up survey carried out by the writer, of cramp difficult. None have yet been recorded the results of which will be published in a later paper. as occurring more than five years after operation. Type of Operation.-The operation performed was either a laminectomy or a hemilaminectomy, with Incidence of Cramp.-Cramps occurred as a pre- exploration of the disc spaces between the fourth and operative symptom in sixteen out .of the 204 cases fifth lumbar vertebra and the lumbosacral articulation. in the series (8 per cent.). It occurred after As much prolapsed material as possible was removed, operation in fifty-two cases (26 per cent.). Of and if exploration was negative further spaces were these postoperative cases, in the group of sixty-two on October 1, 2021 by guest. investigated if this wa's thought necessary by the cases not having a sensory'root divided, nine (15 operating surgeon. In about two-thirds of the cases per cent.) developed cramps, whereas, in the 142 division of one or two sensory roots, either at the same cases having a posterior root division, forty-three segmental level as the disc or at the segment above, was made. This procedure was adopted in' an attempt to (30 per cent.) developed cramps. Thus cramps be certain that pain was relieved (Walker, 1945) and to appear twice as commonly in the cases having -avoid further root pressure if more material should division of sensory roots as in those not having prolapse. this performed. 251 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.3.251 on 1 August 1949. Downloaded from 0, .~~~~~~~~~~~~~~~~~~~~~~~~ 252' LIONEL- WOLMAN TABLE I Precipitating Cause of Cramps.-AII the patients AGE AND SEX INCIDENCE OF CASES- were asked what factors brought on the cramp. The replies (Table II) showed that nocturnal cramp Series ino Average Age of Aof Men Women occurred in more than half the cases. series age youngest e est Pre- operative Factors Relieving Cramp.-The cramp passed of cramps .. .. 16 38 20 54 15 1 Postoperative spontaneously in all the patients in whom it cramps . .. 52 36 17 50 43 9 occurred pre-operatively, but could be relieved by Cases without cramp .. .. 136 36 17 68 112 24 rubbing the affected part or by pressing the foot Whole series .. 204 36 17 68 170 34 against something firm. In the fifty-two patients in whom cramp was postoperative, changing -the position of the leg was most effective and relieved Of the sixteen patients complaining of cramp in before operation, ten were relieved of this symptom cramp fifteen cases, pressing the foot to the after operation, while in the remaining six the ground was successful in ten, and six found that cramps were6 more frequent and severe afterwards rubbing the affected part gave relief. Three patients in all but one, whose cramps persisted at about the thougzht they could relieve cramp by taking aspirin same frequency and intensity. It has been men- before going to bed, and eight cases used'a combina- tioned already that the cramp in these cases tends TABLE 1II to come on at night while the patient is in bed, thus differentiating the pain from that of inter- MUSCLES AFFECTED BY CRAMP mittent claudication. A further point of difference Pre-operative cases Postoperative cases is the age incidence, which is shown in Table I. Part Weak- Weak- It will be seen that the average age of the -atients affected Weak- ness Weak- ness was the same as in No. % ness and No. % ness and with cramp approximately the Protected by copyright. only wast- only wast- whole series of sciatica cases; this suggests that ing ing vascular factors of a degenerative type play no part in the causation of the cramp. Thigh .. 2 13 0 1 3 6 1 2 Thigh and Sex Incidence.-The sex of the patients with calf .. 1 6 1 0 6 11 0 1 cramp is shown in Table I. Although pre-operative cramps were commoner in men than in women, the Calf .. 9 56 5 4 29 56 10 5 sex distribution in the group with cramp after Calf and foot 1 6 1 0 5 10 0 0 operation was similar to that for the whole series Foot and toes 3 19 1 0 9 17 2 2 (about five men to one woman); this suggests Total.. 16 100 100 that sex has no part in the aetiology of these cramps. _-52 II tion of all these methods to obtain relief. The - TABLE remaining ten adopted no particular measures but PRECIPITATING FACTORS IN CRAMP allowed the cramp to pass off spontaneously. No. with No. with Precipitating factor pre- post- Site of Cramp.-The muscles affected by cramp operative operative are indicated 'in Table III. As many observers cramp cramp have previously noted, the calf m'uscles are -by far http://jnnp.bmj.com/ the commonest site for muscular cramps. In the In bed at night .. .. .. 7 32 sixteen pre-operative cases, wasting of the affected muscles was found in five patients, while in all While bending or kneeling .. 0 3 except three there was definite weakness of these While sitting .. .. .. 2 3 muscles compared with the opposite side. Fibrilla- tion was seen in the calf in two patients only. In Stretching leg .. .. .. 2 0 the fifty-two postoperative cases weakness and on October 1, 2021 by guest. While standing with weight wasting were less frequently found in the affected on leg.. .. .. .. 0 3 muscles, there being ten patients with wasting and twenty-three with weakness. As cramps were No definite cause-cramp at fairly infrequent by the time of the follow-up, this any time of day or night .. 5 11 observation is of doubtful significance. The dis- tribution of the weakness and wasting is shown in Total . .. .. 16 52 Table III. J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.12.3.251 on 1 August 1949. Downloaded from CRAMP AND PROLAPSED DISC 253. TABLE IV medial or lateral position, there is no definite RELATIONSHIP OF CRAMP TO THE LEVEL OF THE correlation between the muscle affected by cramp PROLAPSED DISC and the level of the prolapsed disc. The type of disc found at operation, especially as regards the Cases with Cases with Remainder pre- post- of cases position of prolapsed material, was therefore Site of prolapsed operative operative without disc tramp cramp cramp investigated next.
Load more

Recommended publications
  • Cramp Fasciculation Syndrome: a Peripheral Nerve Hyperexcitability Disorder Bhojo A
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by eCommons@AKU Pakistan Journal of Neurological Sciences (PJNS) Volume 9 | Issue 3 Article 7 7-2014 Cramp fasciculation syndrome: a peripheral nerve hyperexcitability disorder Bhojo A. Khealani Aga Khan University Hospital, Follow this and additional works at: http://ecommons.aku.edu/pjns Part of the Neurology Commons Recommended Citation Khealani, Bhojo A. (2014) "Cramp fasciculation syndrome: a peripheral nerve hyperexcitability disorder," Pakistan Journal of Neurological Sciences (PJNS): Vol. 9: Iss. 3, Article 7. Available at: http://ecommons.aku.edu/pjns/vol9/iss3/7 CASE REPORT CRAMP FASCICULATION SYNDROME: A PERIPHERAL NERVE HYPEREXCITABILITY DISORDER Bhojo A. Khealani Assistant professor, Neurology section, Aga khan University, Karachi Correspondence to: Bhojo A Khealani, Department of Medicine (Neurology), Aga Khan University, Karachi. Email: [email protected] Date of submission: June 28, 2014, Date of revision: August 5, 2014, Date of acceptance:September 1, 2014 ABSTRACT Cramp fasciculation syndrome is mildest among all the peripheral nerve hyperexcitability disorders, which typically presents with cramps, body ache and fasciculations. The diagnosis is based on clinical grounds supported by electrodi- agnostic study. We report a case of young male with two months’ history of body ache, rippling, movements over calves and other body parts, and occasional cramps. His metabolic workup was suggestive of impaired fasting glucose, radio- logic work up (chest X-ray and ultrasound abdomen) was normal, and electrodiagnostic study was significant for fascicu- lation and myokymic discharges. He was started on pregablin and analgesics. To the best of our knowledge this is report first of cramp fasciculation syndrome from Pakistan.
    [Show full text]
  • Nocturnal Leg Cramps: Is There Any Relief?
    Nocturnal leg cramps: is there any relief? Nocturnal leg cramps are common, particularly in older people and in women who are pregnant. The condition is characterised by painful cramps in the legs or feet, that affect sleep quality. Is there an effective treatment? Unfortunately, treatment options are limited, but lifestyle modifications and gentle stretching may have some effect. Pharmacological treatment may be considered for people with frequent, severe leg cramps, however, quinine is no longer recommended. What are nocturnal leg cramps? Factors known to be associated with an increased risk of nocturnal cramping, include:1 A nocturnal leg cramp is a sudden contraction of muscles in the leg or foot during sleep. This painful tightening of the Age over 50 years muscle can last from a few seconds to several minutes. Cramps Pregnancy often cause waking, and although the cramps themselves are Exercise, particularly over-exertion benign, the affected muscle may be painful for some hours Leg positioning, e.g. prolonged sitting with legs afterwards and the consequences of sleep impairment can be crossed, tight bed covers which cause the toes to point considerable. downwards Excessive consumption of alcohol Severe nocturnal cramps are characterised by painful, incapacitating episodes, which last on average for nine Chronic dehydration minutes, and recur intermittently throughout the night.1 Structural disorders, e.g. flat feet or other foot and ankle This can lead to secondary insomnia and impaired day-time malformations functioning. Approximately 20% of people who experience Medicines, e.g. diuretics (especially thiazide and regular nocturnal cramps have symptoms severe enough to potassium-sparing diuretics), some anti-inflammatories affect sleep quality or require medical attention.1 (e.g.
    [Show full text]
  • Limb Dystonia Including Writer's Cramp
    Limb dystonia including writer’s cramp Limb dystonia can occur in primary dystonias or as a complication in neurodegenerative diseases e.g. Huntington’s disease, Wilson’s disease or Parkinson syndromes or other diseases like structural brain damage, peripheral trauma or drug-induced. Any muscle group under voluntary control can be affected, dystonic muscle overactivity can occur during rest, be aggravated by movement, or occur only during voluntary movement (action dystonia). If the dystonia is triggered by a specific task, it is called “task-specific” dystonia and affects mostly the hand. As task-specific dystonia causes most disability and is the greatest therapeutic challenge, this summary will focus mainly on this form of limb dystonia. Exercises with a repetitive movement pattern such as writing, typing or playing musical instruments are predestinated to this type of dystonia (1). Co-contraction of agonist and antagonist muscles lead to abnormal postures and movements sometimes associated with tremor or myoclonic jerks. This leads to disability in occupations with repetitive fine motor tasks. The underlying pathophysiology why some individuals develop such a task-specific dystonia and others not, despite of maybe excessive overuse of the hand remains unclear. Safety and efficacy of botulinum toxin has been well established during decades of use (2). Pathophysiology Numerous studies in task-specific dystonias have shown abnormalities within the basal ganglia and its circuits, decreased inhibition at various levels of the sensorimotor system, abnormal plasticity and impaired sensorimotor processing (3). MRI- based volumetric techniques have shown changes in the basal ganglia, thalamus and gray matter of the sensorimotor cortex (4).
    [Show full text]
  • Physiotherapy of Focal Dystonia: a Physiotherapists Personal Experience
    European Journal of Neurology 2010, 17 (Suppl. 1): 107–112 doi:10.1111/j.1468-1331.2010.03061.x Physiotherapy of focal dystonia: a physiotherapistÕs personal experience J.-P. Bleton Universite´ Paris Descartes INSERM U894, Service de Neurologie, Hoˆpital Sainte-Anne, Paris, France Keywords: The approach of the physiotherapist to each form of dystonia is individual and has to dystonia, physiotherapy, be specific. There is not one single method but several strategies related to the different cervical dystonia, writerÕs clinical forms. Although there is no standard programme applicable to all forms of cramp, writing tremor, cervical dystonia, we can distinguish a number of guidelines for the different clinical relaxation, pen grip forms. In the myoclonic form, emphasis is placed on seeking to immobilize the head, training and for the tonic form, on rehabilitating corrector muscles. Physiotherapy and bot- ulinum toxin injections mutually interact in order to reduce the symptoms. Recent Received 3 August 2009 studies have shown the clinical benefits of physiotherapy. The physiotherapy of wri- Accepted 5 March 2010 terÕs cramp is designed as a re-learning process. The first step is to perform exercises to improve independence and precision of fingers and wrist movements. Then, the muscles involved in the correction of dystonic postures are trained by drawing loops, curves and arabesques. The aim of rehabilitation is not to enable patients with writerÕs cramp to write as they used to, but to help their dysgraphia evolve towards a fast, fluid and effortless handwriting. A reshaping of the sensory cortical hand representation appears to be associated with clinical improvement in patients with dystonia after rehabilitation.
    [Show full text]
  • The Clinical Approach to Movement Disorders Wilson F
    REVIEWS The clinical approach to movement disorders Wilson F. Abdo, Bart P. C. van de Warrenburg, David J. Burn, Niall P. Quinn and Bastiaan R. Bloem Abstract | Movement disorders are commonly encountered in the clinic. In this Review, aimed at trainees and general neurologists, we provide a practical step-by-step approach to help clinicians in their ‘pattern recognition’ of movement disorders, as part of a process that ultimately leads to the diagnosis. The key to success is establishing the phenomenology of the clinical syndrome, which is determined from the specific combination of the dominant movement disorder, other abnormal movements in patients presenting with a mixed movement disorder, and a set of associated neurological and non-neurological abnormalities. Definition of the clinical syndrome in this manner should, in turn, result in a differential diagnosis. Sometimes, simple pattern recognition will suffice and lead directly to the diagnosis, but often ancillary investigations, guided by the dominant movement disorder, are required. We illustrate this diagnostic process for the most common types of movement disorder, namely, akinetic –rigid syndromes and the various types of hyperkinetic disorders (myoclonus, chorea, tics, dystonia and tremor). Abdo, W. F. et al. Nat. Rev. Neurol. 6, 29–37 (2010); doi:10.1038/nrneurol.2009.196 1 Continuing Medical Education online 85 years. The prevalence of essential tremor—the most common form of tremor—is 4% in people aged over This activity has been planned and implemented in accordance 40 years, increasing to 14% in people over 65 years of with the Essential Areas and policies of the Accreditation Council age.2,3 The prevalence of tics in school-age children and for Continuing Medical Education through the joint sponsorship of 4 MedscapeCME and Nature Publishing Group.
    [Show full text]
  • From Sandie's Desk
    From Sandie’s Desk Dystonia One of the questions that people living with Parkinson’s often ask us is “is there pain associated with Parkinson’s?” Pain is a common symptom and it is our bodies’ way of telling us that something isn’t right and oth- er causes need to be investigated – we should not jump to the conclu- sion that any and all pain is due to Parkinson’s disease. We all can get different kinds of aches and pains for various reasons, so it is important to talk to your doctor to sort out what the cause of these aches and pains are. That said, pain is common among those living with Parkinson’s but does not get much publicity. Just as with everything else related to Parkin- son’s, everyone is different and not everyone will experience this prob- lem but for some people, pain can be the main symptom of their condi- tion. For some people, it may be discomfort brought on by stiff muscles, which have a harder time moving. Hard muscles may bring on some cramps, but this can usually be “worked out” by gently stretching the muscle. For some people, there may be a much more difficult type of cramping pain, which is referred to as dystonia. Dystonia can be confusing to understand, and when people try to get in- formation about it especially online, they end up more confused. In general, Sandie Jones dystonia can be described as involuntary muscle contractions, which can cause twisting, jerking and tighten different parts of your body, for a SUS- Sandie Jones trained as a TAINED period of time.
    [Show full text]
  • Porro NEWORK NEWS
    International Polio Network SAINT LOUIS, MISSOURIUSA Winter 2003 .Vol. 19, No. 1 Porro NEWORKNEWS Straight Answers to Your "Cramped" Questions Holly H. Wise, P7; PhD, and Kerri A. Kolehma, MS, MD, Coastal Post-Polio Clinic, Charleston, South Carolina Tired in the morning? Is it diffi- Cramps can occur throughout origins anywhere in the central cult to get comfortable for a good the day but more often occur at and peripheral nervous systems night of sleep? A complaint often night or when a person is resting. and may explain the wide range reported at the Coastal Post-Polio Although it is not known exactly of conditions in which the Clinic in Charleston, South why cramps happen mostly at cramping occurs (Bentley, 1996). Carolina, is the inability to get these times, it is thought that to sleep at night due to leg pain, the resting muscle is not being Seeking Answers twitching, or cramping. stretched and is therefore more A thorough history and possibly easily excited. Muscle cramping is a relatively a referral for screening labs will common, painful, and bother- The basis for the theory that help determine the causes for some complaint among generally I cramps occur more at rest, due to I leg pain and cramping. Polio healthy adults, and is more com- I the muscle not being stretched, I survivors can provide a descrip- mon in women than men. Some I is that passive stretching can I tion of their muscle cramps, studies estimate as many as 50- 1 relieve muscle cramping. Pain I identification of the time and 70% of older adults may experi- I associated with cramping is likely I place when they occur, and an ence nocturnal leg and foot I caused by the demand of the I activity log of the 24-48 hours cramps (Abdulla, et.
    [Show full text]
  • A Patient's Guide to Muscle Cramps Or Striated Muscles Are Those That We Move by Choice (For Example, the Muscles in Your Arms and Legs)
    A Patient’s Guide to Muscle Cramps The Central Orthopedic Group 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 [email protected] Compliments of: The Central Orthopedic Group DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailmentsA orPatient's treatments. The Guide information to should Muscle NOT be usedCramps in place of a visit with your health care provider, nor should you disregard the advice of your health care provider because of any information you read in this booklet. The Central Orthopedic Group The Central Orthopedic Group 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 [email protected] http://thecentralorthopedicgroup.com All materials within these pages are the sole property of Medical Multimedia Group, LLC and are used herein by permission. eOrthopod is a registered trademark of Medical Multimedia Group, LLC. 2 Compliments of: The Central Orthopedic Group A Patient's Guide to Muscle Cramps or striated muscles are those that we move by choice (for example, the muscles in your arms and legs). These muscles are attached to bones by tendons, a sinewy type of tissue. Involuntary muscles, or smooth muscles, are the ones that move on their own (for example, the muscles that control your diaphragm and help you breathe). The muscles in your heart are called involuntary cardiac muscles. Introduction You have over 600 muscles in your body. These muscles control everything you do, from breathing to putting food in your mouth to swallowing.
    [Show full text]
  • Clinical and Genetic Overview of Paroxysmal Movement Disorders and Episodic Ataxias
    International Journal of Molecular Sciences Review Clinical and Genetic Overview of Paroxysmal Movement Disorders and Episodic Ataxias Giacomo Garone 1,2 , Alessandro Capuano 2 , Lorena Travaglini 3,4 , Federica Graziola 2,5 , Fabrizia Stregapede 4,6, Ginevra Zanni 3,4, Federico Vigevano 7, Enrico Bertini 3,4 and Francesco Nicita 3,4,* 1 University Hospital Pediatric Department, IRCCS Bambino Gesù Children’s Hospital, University of Rome Tor Vergata, 00165 Rome, Italy; [email protected] 2 Movement Disorders Clinic, Neurology Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, 00146 Rome, Italy; [email protected] (A.C.); [email protected] (F.G.) 3 Unit of Neuromuscular and Neurodegenerative Diseases, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, 00146 Rome, Italy; [email protected] (L.T.); [email protected] (G.Z.); [email protected] (E.B.) 4 Laboratory of Molecular Medicine, IRCCS Bambino Gesù Children’s Hospital, 00146 Rome, Italy; [email protected] 5 Department of Neuroscience, University of Rome Tor Vergata, 00133 Rome, Italy 6 Department of Sciences, University of Roma Tre, 00146 Rome, Italy 7 Neurology Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; [email protected] * Correspondence: [email protected]; Tel.: +0039-06-68592105 Received: 30 April 2020; Accepted: 13 May 2020; Published: 20 May 2020 Abstract: Paroxysmal movement disorders (PMDs) are rare neurological diseases typically manifesting with intermittent attacks of abnormal involuntary movements. Two main categories of PMDs are recognized based on the phenomenology: Paroxysmal dyskinesias (PxDs) are characterized by transient episodes hyperkinetic movement disorders, while attacks of cerebellar dysfunction are the hallmark of episodic ataxias (EAs).
    [Show full text]
  • Muscle Cramps Reliable and Validated Outcome Measures and New Treatments Are Needed
    NEUROMUSCULAR DISORDERS Muscle Cramps Reliable and validated outcome measures and new treatments are needed. By Hans D. Katzberg, MD, MSc, FRCPC and Hamid Sadeghian, MD, FRCPC What Is a Muscle Cramp? limb syndromes) and peripheral processes, including tetany, A muscle cramp is a hyperexcit- myokymia, myotonia, neuromyotonia (focal muscle stiff- able neurologic phenomena of ness), or myalgia.6 excessive, involuntary muscle The origin and propagation of neurogenic muscle cramps contractions.1,2 It is important localizes to peripheral and central targets (Figure 1), including to distinguish between myogen- the neuromuscular junction, where mechanical disruption ic and neurogenic muscle cramps, because each has unique and electrolyte disturbances can influence hyperexcitability pathophysiology and management.3 The conventional defi- and cramp generation. Injury to peripheral nerve components nition of a muscle cramp is a painful contraction of a muscle including the motor neuron cell bodies or the motor axons or muscle group, relieved by contraction of antagonist can result in ephaptic transmission and development of mus- muscles.4 Colloquially, muscle cramps are known by a num- cle cramps. Dysfunctional intramuscular small fiber sensory ber of different terms depending on the country, including afferents (eg, mechanoreceptors and spindles) are also pro- charley horse in the US, chopper in England, and corky in posed to be involved in cramp generation.7-10 Centrally, persis- Australia.5 Care must be taken to avoid confusing muscle tent inward currents mediated by GABAergic transmitters at cramps with other phenomena including central hyperexcit- the spinal level can amplify incoming sensory input and lead ability (eg, dystonia, spasticity, seizures, and stiff person/stiff to the propagation and amplification of cramp potentials.11 Figure 1: Pathophysiology Underlying Neurogenic Muscle Cramps.
    [Show full text]
  • Hereditary Persistent Distal Cramps'
    Journal ofNeurology, Neurosurgery, and Psychiatry, 1972, 35, 379-384 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.35.3.379 on 1 June 1972. Downloaded from Hereditary persistent distal cramps' ANICA JUSIC, S. DOGAN, AND V. STOJANOVIC From the Department of Neurology and Psychiatry, University ofZagreb School of Medicine, Zagreb-Rebro, Yugoslavia SUMMARY A disease consisting of persistent muscle cramps involving distal muscle groups that occurred in 12 members of the same family is described. The cramps appeared on exertion and in full relaxation or during sleep. In the third generation they appeared in the second decade; in the fourth and fifth generations in childhood with higher frequency and intensity of cramps. The disease is not sex linked and seems to be dominantly inherited. Electromyography showed no myotonic response on insertion. Motor unit potentials were normal. Continual waxing and waning electrical discharges corresponding to clinically visible contractions of parts of the muscles were present. Repetitive nerve stimulation caused no change in the amplitude of evoked muscle potentials. On spinal anaesthesia or nerve block the muscle contractions continued but became painless. The movements were only stopped with local infiltration of anaesthetic into the muscle. There were no cramps on ischaemic work. Drug studies revealed no benefit on carbamazepine, slight relief with meprobamate, and complete disappearance with potassium chloride. The remission outlasted the treatment for three months and then cramps of milder degree reappeared. Repeated potassium chloride treatment was Protected by copyright. not effective. The cramps increased on hydrochlorothiazide, and 12 hours after spinal anaesthesia. In the authors' opinion the disease should be considered as not belonging to any known nosological entity.
    [Show full text]
  • Muscle Selection for Focal Limb Dystonia
    toxins Review Muscle Selection for Focal Limb Dystonia Barbara Illowsky Karp 1,* and Katharine Alter 2 ID 1 Combined NeuroScience IRB, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA 2 Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, MD 20892, USA; [email protected] * Correspondence: [email protected] Received: 23 October 2017; Accepted: 13 December 2017; Published: 29 December 2017 Abstract: Selection of muscles for botulinum toxin injection for limb dystonia is particularly challenging. Limb dystonias vary more widely in the pattern of dystonic movement and involved muscles than cervical dystonia or blepharospasm. The large variation in how healthy individuals perform skilled hand movements, the large number of muscles in the hand and forearm, and the presence of compensatory actions in patients with dystonia add to the complexity of choosing muscles for injection. In this article, we discuss approaches to selecting upper and lower extremity muscles for chemodenervation treatment of limb dystonia. Keywords: limb dystonia; writer’s cramp’ musician’s cramp; lower limb dystonia; runners dystonia; chemodenervation; botulinum toxin; muscle selection; gait testing 1. Introduction 1.1. Background, Genetics, Pathophysiology: Focal Upper Limb Dystonia The current definition of dystonia describes it as “a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both. Dystonic movements are typically patterned, twisting, and may be tremulous. Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation [1]”. These features are exemplified by focal hand dystonia, especially those that are task-specific.
    [Show full text]